KeyResponsibilities:

·Drives theimplementation of programs, policies, initiatives, and tools for ChargeCapture, including but not limited to institutional system-wide charge captureprocesses to ensure efficiency and effectiveness.

·Improvement ofdepartment processes and procedures to assure timely and accurate capture ofall chargeable activities

·Development ofaction plan with responsible parties and due dates of issues identified

·Development ofpolicies and procedures, monitoring tools for late charges and establishment ofprocedures for timely and accurate charge capture mechanisms

·Development andmaintenance of collaborative working relationship with revenue producingdepartments, information systems personnel, technical and clinical personnel toidentify chargeable activities, to establish charge capture mechanisms, andorderly and timely recording of revenue

·Collaborateswith Clinical Physician Leaders and Departments to review new technologies andestablish related charge capture and coding protocols

·Directs andfacilitates the development of corrective action plans related to anydeficiencies noted concerning charge capture effectiveness and systemintegration. This includes evaluation and identification of root causesresulting in charge capture deficiencies or lack of revenue recognition

·Reviews revenuefor potential system optimization/enhancements to ensure consistent chargecapture, including revenue guardian rules, claim edits and DNBs to act as stopgap measures for revenue leakage

·Develops andexecutes Charge Audit Approach identifying department(s) for review includingchart documentation on a regular basis to verify the clinical documentationsupports the charges billed, prepare a summary report of findings, and sharewith department leadership. Oversees CDM Annual Audit and Charge Capture Audit

·Develops andmonitors KPIs related to charging practices and reports metrics to revenuegenerating department leadership

·Directs thedesign/redesign of CDM processes and systems to improve service and dataintegrity

·Maintainsoversight of Charge Master Development, working closely with Revenue GeneratingClinical Departments to ensure that coding, revenue codes, descriptionnomenclature patient billable vs. non-billable, catalog development and updates(add/delete/change) for all CDM items are appropriate, verified through monthlyfeedback from Executive Leadership

·Ensures annualdepartment CPT/HCPCS coding and CDM maintenance updates coincide with the CMSannual updates to the Hospital Outpatient Prospective Payment System

·Reviewsexisting processes to ensure proper controls are in place for the maintenanceand reconciliation of CDM updates utilizing CDM Manager

·Ensure annualCDM Pricing is updated and implemented

·Serves as aregulatory resource of Medicare, Medicaid, Medicaid OPPS reimbursement andother 3rd party billing rules and coverage through self-directed education andcommunication across the enterprise

·Acts as aSubject Matter Expert for Revenue Integrity/Charge Capture and for professionaland technical CDM related issues building strong relationships with theclinical departments

·Monthly meetingwith involved departments to address billing/charge-capture compliance concerns

·Leads RIOperations meetings, steering committee, manager meetings and providers updatesin other VP/C-level forums where appropriate

·Monitors systemreports and monitoring tools to track commercial and government payer denialsand appeals related to revenue integrity for both hospital and physician revenue

·Serves asmanaging leader when reporting on charge related denials, appeals, auditfindings and coding variations

·Analyzes weeklycharge reconciliation and missing charge reports in order to verify thatdepartments have captured all charges, and compile findings in departmentalcharge capture performance reports.

·Proactivelyidentifies any charge trends and utilizes this information to determine focusedreviews of specific departments. Provide education to staff based on findings.

·Maintainspersonal professional growth and development through seminars, workshops andprofessional affiliations.

·Establishesgoals and objective for each employee to measure performance and cross trainingto mutually agreed-upon expectations and provides employees access to resourcesneeded in progressing in their development plans.

·Ensures serviceand work quality to meet UCSD, state and federal rules and regulations.Utilizes work quality monitoring to ensure that policies and procedures,objectives, performance improvement, attendance, safety and environment, and infectioncontrol guidelines are followed.

·Adhere tocurrent organizational Performance Improvement priorities.

·Participate inquality studies through data collection.

·Makerecommendations and take actions to improve structure, system or outcomes.

·Ensures thatcompliance to rules, regulations, operations, contracts, internal and externalrules, state and federal requirements are met.

·Followsestablished UCSD department policies, procedures, objectives, performanceimprovement, attendance, safety, environmental, and infection controlguidelines, including adherence to the workplace Code of Conduct and CompliancePlan. Practices a high level of integrity and honesty in maintainingconfidentiality

Requirements

MINIMUM QUALIFICATIONS

·Bachelor'sDegree in business, healthcare administration or related area and a minimum ofeight (8 ) or more years of directly relevant healthcare revenue cycleexperience; OR equivalent combination of experience and education/training.

·Experience andproven success in knowledge of healthcare revenue cycle operations, concepts,and policies and their impact throughout the organization, with an in-depthunderstanding of related functions and issues, including coding anddocumentation standards, registration, billing and collection processes,reimbursements, aging accounts, contractual adjustments, and charge capture.

·Ability toconduct and interpret qualitative and quantitative analysis, financialanalysis, healthcare economics and business processes, information systems,organizational development, health care delivery systems, project management ornew business development.

·Knowledge ofCMS regulations, medical terminology and the various data elements associatedwith the UB-04 and CMS-1500 claim form.

·Knowledge ofmedical records, hospital bills, service item master and CDM

·Knowledge ofprinciples and practices of organization, administration, fiscal and personnelmanagement.

·Thoroughknowledge of local, state and federal regulatory requirement related to thefunctional area.

·Strong abilityto provide leadership and influence others.

·Proven abilityto mediate and resolve complex problems and issues.

·Ability tofoster effective working relationships and build consensus.

·Ability todevelop long-range business plans and strategy.